Testimonial Release Form

I hereby grant Washington Health System Washington Hospital to use my testimonial in any and all of its publications, including website entries, without payment or any other consideration.

I understand and agree that these materials will become property of Washington Health System Washington Hospital and will not be returned.

I hereby authorize Washington Health System Washington Hospital to exhibit, publish or distribute this testimonial for purposes of publicizing Washington Health System Washington Hospital or for any other lawful purpose.

I hereby hold harmless and release and forever discharge Washington Health System Washington Hospital from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I am at least 18 years of age and am competent to contract in my own name. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.

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By clicking the "Submit" button below you agree to the terms of this release form.